Overview

Staff in this program

Specialized Care From a Multidisciplinary Team

Every year the Functional Neurosurgery Center at Massachusetts General Hospital successfully treats more than 100 patients from across the United States and around the world. Each patient’s treatment is managed by a team of specialists that includes:

Neurosurgeons

Neurologists

Neuroradiologists

Neuropsychologists

Nurse practitioners

Our neurosurgeons meet regularly to review each patient’s case and, by consensus, recommend the least invasive, most effective surgical treatment. Our goal is to improve each patient's quality of life.

Controlling Epileptic Seizures

For most epilepsy patients, appropriate medicine is sufficient to control seizures. However, in 20-30% of cases surgery may be helpful.

Presurgical evaluation includes a detailed clinical history and physical examination, advanced neuro-imaging, video-EEG monitoring, neuropsychological testing and an assessment of psychosocial functioning. In some cases, implanted intracranial electrodes are used to gather more precise information. After the evaluations our neurosurgeons operate to remove or disconnect the affected areas of the brain using one or more of the following procedures:

Lesionectomy

Lobectomy

Hemispherectomy

Corticectomy

Callosotomy

Subpial transection

Vagal stimulation

In all cases, the goal of epilepsy surgery is to remove the area of the brain from which the seizures originate without causing any significant functional impairment.

Relief of Chronic Pain and Tics

The chronic, intense facial pain of trigeminal neuralgia (tic doloureux) and glossopharyngeal neuralgia can be disabling. Hemifacial spasm, or tic convulsif, is not painful but can still cause uncontrollable facial contractions.

All of these tics are typically the result of an artery or vein compressing a cranial nerve. If medication cannot control the symptoms effectively, our surgeons are often able to relieve the pressure and stop the pain by moving the blood vessel in a procedure called microvascular decompression.

Stereotactic radiofrequency thermal lesioning is a technique, developed at Mass General, that is used to treat pain symptoms. Surgeons make a precise lesion in the affected nerve, causing mild facial numbness.

Hemifacial spasms may also be treated with botulinum toxin (botox) injection. If these treatments do not work, then the spasms can be treated with surgery.

Deep Brain Stimulation for Movement Disorders

Our neurosurgeons use deep brain stimulation (DBS) to treat patients with a wide variety of movement disorders. DBS involves implanting an electrode in the brain to interrupt and stimulate nerve activity. Our center uses the most advanced stereotactic technology, microelectrode recordings, for optimal lead positioning and the best patient outcome. The most common movement disorder we treat is Parkinson's disease. Other disorders that can be treated using deep brain stimulation include Essential tremor and Dystonia.

Mass General was one of the first hospitals to perform DBS and today we also use it to treat many different types of Dystonia which include:

Genetic dysonia

Generalized dystonia

Hemidystonia

Segmental dystonia

Focal dystonia, such as Spasmodic torticollis

Surgical Treatment of Psychiatric Disease

The Stereotactic and Functional Neurosurgery Center offers a range of treatments for appropriate patients with severe and medically intractable Obsessive-compulsive disorder (OCD) and Major depression. Patients with severe and medically intractable Major depression or OCD are potential candidates for surgery.

Although many procedures have been used in the past, our neurosurgeons perform a broad range of treatment options including:

Deep brain stimulation for OCD

Deep brain stimulation for Depression (This is experimental and performed only under protocol)

Vagal nerve stimulation for Depression

Cingulotomy

Subcaudate tractotomy

Patients interested in more information under the psychiatric section should contact Ms. Valerie Giorgione at 617-726-3407.

Focus on the Most Effective Treatment

These programs typically prescribe medication as the first line of defense against Parkinson’s disease and epilepsy. We consider surgery to be appropriate only when medical treatments are no longer effective or the side effects are too severe for the patient.

A High-Volume, Highly Specialized Center

We are one of the largest functional neurosurgery centers in the United States. As a major referral center, we treat approximately 70 to 90 patients per day, and our surgeons perform 2,600 procedures a year.

As a result of this high volume, our surgeons have more experience with rare cases that a smaller hospital might see infrequently, if at all.

Searching for New Treatments

Our physicians are Harvard Medical School faculty who:

Conduct research to better understand the underlying causes of neurological disorders

Participate in the research and development of innovative surgical therapies

Publish extensively in leading academic journals and present their findings at major scientific meetings

A major area of clinical research is surgery for epilepsy. Candidates for epilepsy surgery are intensively studied by electrophysiological and imaging techniques. Electrophysiologically, implanted electrodes are used to monitor seizure activity in awake patients. PET imaging is used to localize motor and language areas. New technology allows superimposition of the PET images with MRI scans, providing sharply defined landmarks during surgery. A further area of exploration is the use of virtual imaging in the operating room.